Screening and treatment for mental disorders is virtually non-existent in many HIV clinics around the world

The proportion of HIV treatment clinics that screen for depression, anxiety, and post-traumatic stress disorder (PTSD) is 50%, 14%, and 12%, respectively, in many regions of the world, Dr. Angela Parcesepe from the University of North Carolina at the 24th International AIDS Conference (AIDS 2022) this week in Montreal. Additionally, both screening and medications to treat depression, anxiety, and PTSD are only available at 36%, 11%, and 8% of sites, respectively.

Common mental disorders, including depression, anxiety and PTSD, are common in people living with HIV and are associated with poor HIV treatment outcomes. Integrating their screening and treatment into HIV care can improve mental health, HIV treatment outcomes, and quality of life. However, data on the availability of mental health screening and treatment in HIV clinics remains scarce.

glossary

depression

A mental health problem that causes a long-lasting bad mood that interferes with everyday life.

fear

A feeling of discomfort, such as B. Worry or fear, which can be mild or severe. Anxiety disorders are conditions in which fear dominates a person’s life or is experienced in certain situations.

middle-income countries

The World Bank classifies countries according to their income: low, lower middle, upper middle and high. There are about 50 lower-middle-income countries (mainly in Africa and Asia) and about 60 upper-middle-income countries (in Africa, Eastern Europe, Asia, Latin America and the Caribbean).

low-income countries

The World Bank classifies countries according to their income: low, lower middle, upper middle and high. While the majority of the 30 or so low-income countries are in sub-Saharan Africa, many African countries, including Kenya, Nigeria, South Africa and Zambia, are in the middle-income bracket.

Using data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium, the 2020 survey collected information on HIV clinics in Asia, the Caribbean, Latin America, sub-Saharan Africa, North America and Australia and reported on the availability of screening and treatment for depression , anxiety and PTSD.

A total of 223 HIV treatment centers from 41 countries took part in the survey. 67% were in urban settings, 50% served adults and children, 38% served adults only, and 12% served children only. Most locations (78%) were in low- and middle-income countries.

On the clinical setting: Urban clinics were more likely to report screening and treatment than rural clinics. Similarly, more clinics in high-income countries offered mental health services.

On populations served: Clinics that served both adults and children were screened for depression more often (53%) than pediatric-only clinics (31%). However, pediatric-only clinics screened for anxiety more often (23%) than adult-pediatric clinics (13%).

In global regions: Clinics in Latin America and the Caribbean offered screening for depression (63%) and anxiety (13%), but no site reported screening for PTSD. In the African cohorts, East Africa was screened for depression (53%) and PTSD (14%) more frequently than other African regions, but had the lowest screening for anxiety (7%). West Africa had minimal screening, with depression, anxiety, and PTSD screened at only 7%, 14%, and 7% of sites, respectively. North America outperformed all regions, testing 93%, 24%, and 28% of HIV treatment centers for depression, anxiety, and PTSD.

dr Parcesepe told AIDS 2022 that they previously conducted this survey between 2016/2017 at 68 clinics in 27 low- and middle-income countries. They compared these results to current (2020) numbers from the same 68 clinics and found that depression and PTSD screening were now available in 31% and 24% of clinics, which did not offer them in 2016/2017. However, 15% and 12% of the clinics that screened for depression and PTSD in the first survey had stopped providing these services in 2020.

She highlighted the lack of screening and treatment for mental health disorders in many rural and pediatric HIV treatment facilities, particularly in low-income countries. She stressed the need to identify and implement practical and sustainable services.

A limitation of the study was that service availability was reported by facility staff and was not independently verified. She also clarified that the 2020 data was collected before COVID-19, so the reported numbers do not reflect the decline in services caused by the pandemic.

references

Parcesepe A et al. Screening and treatment of common mental disorders in HIV clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. 24th International AIDS Conference, Montreal, Abstract OAE0502, 2022.

View the abstract on the conference website.

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